Back pain in the pediatric athlete is rare compared to the adult population. However, the diagnosis should be accurate as most have specific etiologies and treatment. Nearly 50% of the time, the cause of the pain is an injury to the pars interarticularis. A thorough history and careful physical examination should guide the physician to a working differential diagnosis. Based on this, appropriate laboratory and imaging work-up is pursued to arrive at a timely diagnosis and subsequent treatment regimen.